P0955 - An Unconventional Incision for Umbilical Hernia Repair in Children

Background:
The vertical trans-umbilical incision commonly employed for single incision laparoscopic surgery leaves virtually no visible scar. This was adapted as an approach for open umbilical hernia repair. The objective of this study was to determine if this approach was equally efficacious to the standard infra-umbilical incision.

Methodology:
All children (<18 years old) who underwent umbilical hernia repair between September 1, 2012 and February 1, 2020 were included. Procedure times and postoperative outcomes were compared for two different surgical approaches; infra-umbilical and vertical trans-umbilical. Student’s t-test was used to compare procedure times and postoperative complication rates.

Discussion:
A total of 260 patients met inclusion criteria: an infra-umbilical incision was used in 205 individuals (78.8%) and trans-umbilical in 55 (21.2%). Approximately 50% of patients in each group were white and 30% black, with almost a 1:1 male-to-female ratio. At the time of operation, mean age was 4.1 years (sd=2.6) for the infra-umbilical group and 2.5 years (sd=1.7) for the trans-umbilical group, while mean weight was 17.6kg (sd=9.1) and 13.3kg (sd=5.8), respectively. There was no significant difference in mean operative time between infra-umbilical (39.7 minutes, sd=21.3) and trans-umbilical (40.0 minutes, sd=15.6) approaches (p= 0.46). There were more concurrent procedures in the trans-umbilical group (37.5% vs 16.6%, p<0.001). Complications were rare: one patient with an infra-umbilical incision (0.5%) had a wound infection (p=0.84) and two patients, one in the infra-umbilical (0.5%) and one in the trans-umbilical group (1.8%), had a recurrence (p=0.55). Both recurrences were successfully repaired via an open vertical transumbilical incision. Regardless of incision, the majority of patients only required one postoperative clinic visit.

Conclusion:
Pediatric umbilical hernia repair can be safely performed through a vertical trans-umbilical incision with similar procedure times and complication rates to more traditional infra-umbilical approach and may offer an improved cosmetic appearance in some cases.